Thursday, May 26, 2016

Lyme disease guidelines are in the top 5% of all research articles

We are proud to announce that Altmetrics has affirmed the evidence treatment guidelines for Lyme disease are in the top 5% of all research articles. Altmetrics citation-based metrics consists of qualitative data that tracks research publications and their ability to reach and influence their audience. According to Altmetrics, their data encompassed more than 107,000 downloads.

After the guidelines by the Infectious Disease Society of America (IDSA) had been criticized for not addressing the severity of chronic manifestations, ILADS published guidelines in hopes of filling the gap. Due to the growing number of chronic conditions, controversy over treatment, and high level of public concern, ILADS composed their guidelines based on The Grading of Recommendations Assessment Development and Evaluation (GRADE). ILADS assessed and graded available research evidence and shifted their guidelines from evidence to recommendations, providing individuals with a transparent and systematic framework. GRADE took in account the harm and benefits of interventions, patient preferences, and values.

The extended antibiotics recommendation provided by the ILADS guidelines has already been adopted, and that notion is continuing to grow. According to a survey in 2011, 50% of New England physicians believe long-term use of antibiotics was "sometimes useful," while 25% thought it was "always useful." The ILADS guidelines have been incorporated in the ILADS physician training program, accepted by the National Guideline Clearing House, where it can be seen on their website and professional conferences, and it was published in the open accessed journal Expert Review of Anti-Infective Therapy.

To view and download ILADS guidelines, visit: Link to 2014 ILADS guidelines at Expert Review of Anti-infective Therapy

Wednesday, May 25, 2016

Four news articles about Lyme


Efficacy and safety of pharmacological agents in the treatment of early Lyme disease

Efficacy and safety of pharmacological agents in the treatment of erythema migrans in early Lyme borreliosis-systematic review protocol




Thu May 19, 2016 5:14 am (PDT) . Posted by: 

"Rick Laferriere" ri_lymeinfo 

*Efficacy and safety of pharmacological agents in the treatment of 
erythema migrans in early Lyme borreliosis-systematic review protocol *
Torbahn G, Hofmann H, Allert R, Freitag MH, Dersch R, Fingerle V, Sommer 
H, Motschall E, Meerpohl JJ, Schmucker C.
/Systematic Reviews/. 2016 May 3; 5(1):73.

http://dx.doi.org/10.1186/s13643-016-0251-3

Abstract

*Background*
Erythema migrans represents an early cutaneous and most common 
manifestation of Lyme borreliosis. Recommendations regarding 
pharmacological agents, dose and duration of treatment are subject of 
intense debate. This review aims to explore differences in efficacy and 
safety between pharmacological treatments and control treatment.

*Methods*
To identify relevant studies, we will conduct a systematic literature 
search. We will include randomised controlled trials (RCTs) and 
non-RCTs. Eligible comparative studies need to (1) consider patients 
with a diagnosis of erythema migrans resulting from Lyme borreliosis and 
(2) compare different pharmacological agents against each other, against 
any other non-pharmacological treatment, placebo or no treatment.

Two review authors will independently assess included studies for risk 
of bias according to the methods of the Cochrane Handbook for Systematic 
Reviews of Interventions and related to specific study designs. We will 
address patient-relevant outcomes including clinical remission of 
cutaneous symptoms, any treatment-related adverse events, quality of 
life and progressive symptoms such as neuroborreliosis or Lyme carditis 
and flu-like symptoms. Provided that the identified trials are 
comparable in terms of clinical issues, combined estimates will be 
provided.

Estimations of treatment effects will be calculated based on a random 
effects model. Heterogeneity will be evaluated based on /I/^/2/ and 
chi-square test. In case of significant heterogeneity, a pooled estimate 
will not be provided, but heterogeneity will be investigated on the 
basis of methodological and clinical study aspects. We plan subgroup 
analysis to reveal potential differences in the effect estimates between 
patient populations and treatment specifications.

We will consider risk of bias using sensitivity analyses to decide 
whether to rely on the pooled estimates. The quality of a body of 
evidence for individual outcomes will be assessed using the GRADE approach.

*Discussion*
Benefits and harms of pharmacological treatment in erythema migrans have 
not yet been adequately assessed. This systematic review will evaluate 
and summarise available evidence addressing benefits and harms of 
different pharmacological treatments. In addition, this summary of 
clinical evidence will inform decision-making between clinicians and 
patients and will play an important part in patient care.

http://dx.doi.org/10.1186/s13643-016-0251-3

*Free, full text (pdf file, 437 KB)*:
http://systematicreviewsjournal.biomedcentral.com/track/pdf/10.1186/s13643-016-0251-3?site=systematicreviewsjournal.biomedcentral.com
or http://tinyurl.com/hchng68
===
The mission of LymeInfo is to keep you informed of issues that might be of interest to Lyme disease patients.   Postings are not meant to imply that we agree with the content of all items we distribute.

For Lyme information, see:
http://www.LymeInfo.net

Please tell others how to subscribe to this group:
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A prospective evaluation of chronic Babesia microti infection

Thu May 19, 2016 11:23 am (PDT) . Posted by: 
*A prospective evaluation of chronic /Babesia microti/ infection in 
seroreactive blood donors*
Bloch, E. M., Levin, A. E., Williamson, P. C., Cyrus, S., Shaz, B. H., 
Kessler, D., Gorlin, J., Bruhn, R., Lee, T.-H., Montalvo, L., Kamel, H. 
and Busch, M. P.
/Transfusion/, online first May 17, 2016.

http://doi.org/10.1111/trf.13617

Abstract

*BACKGROUND*
/Babesia microti/ is the foremost infectious risk to the US blood supply 
for which a Food and Drug Administration (FDA)-licensed test is 
unavailable for donation screening. Characterization of the antibody 
response to /B. microti/ and correlation with parasitemia is necessary 
to guide screening and donor management policies.

*STUDY DESIGN AND METHODS*
During an FDA licensure trial, blood donors were prospectively screened 
(July-November 2013) using a /B. microti-/specific antibody enzyme 
immunoassay (EIA, Immunetics) in highly endemic (New York [NY]; 
n = 13,688), moderately endemic (Minnesota [MN]; n = 4583), and 
nonendemic (New Mexico [NM]; n = 8451) regions. Blood donors with 
repeat-reactive (RR) results participated in a 12-month prospective 
cohort study using /B. microti/ EIA, immunofluorescent assay, polymerase 
chain reaction (PCR), blood smear, and clinical questionnaire.

*RESULTS*
Thirty-seven (61.67%; 24 NY, seven MN, six NM) of 60 eligible RR donors 
enrolled in the study; 20 of 37 (54%) completed the 12-month follow-up 
visit of which 15 (75%) were still seroreactive. Nine PCR-positive 
donors were identified during index screening; five participated in the 
follow-up study, three were PCR positive at 6 months, and two remained 
positive at final follow-up (378 and 404 days). Most RR donors displayed 
low-level seroreactivity that was either stable or waning during 
follow-up. The level and pattern of reactivity correlated poorly with 
PCR positivity.

*CONCLUSION*
The findings indicate prolonged seropositivity in blood donors. Although 
rare, asymptomatic, persistent PCR positivity supports the current 
policy of indefinite deferral for donors with a history of babesiosis or 
positive test results. Repeat testing by PCR and serology will be 
necessary if reinstatement is to be considered.

http://doi.org/10.1111/trf.13617
===
====
The mission of LymeInfo is to keep you informed of issues that might be of interest to Lyme disease patients.   Postings are not meant to imply that we agree with the content of all items we distribute.

For Lyme information, see:
http://www.LymeInfo.net

Please tell others how to subscribe to this group:
mailto:LymeInfo-subscribe@yahoogroups.com

Tuesday, May 10, 2016

UK Minister orders Lyme Disease review

Ministers have ordered a major review of the diagnosis, treatment and transmission of Lyme disease amid concern about a quadrupling in cases over the past decade.

Public Health minister Jane Ellison made the announcement in the Commons following growing public debate about rising numbers of cases of the condition, which can cause neurological damage and crushing fatigue.

The bacterial infection is carried by infected ticks which are usually found in woodlands.

Read the full story:


Sunday, May 8, 2016

Human pathogens associated with the blacklegged tick

Another good reason to not wait and immediately get it right and "TREAT THE BITE".  

 2016 May 5;9(1):265. doi: 10.1186/s13071-016-1529-y.

Human pathogens associated with the blacklegged tick Ixodes scapularis: a systematic review.

Author information

  • 1Enteric, Zoonotic and Vector-borne Diseases; Communicable Diseases, Emergency Preparedness and Response; Public Health Ontario, Toronto, Ontario, Canada. mark.nelder@oahpp.ca.
  • 2Enteric, Zoonotic and Vector-borne Diseases; Communicable Diseases, Emergency Preparedness and Response; Public Health Ontario, Toronto, Ontario, Canada.
  • 3Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
  • 4Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
  • 5Analytic Services, Knowledge Services, Public Health Ontario, Toronto, ON, Canada.
  • 6Public Health Ontario Laboratories, Public Health Ontario, Toronto, ON, Canada.
  • 7Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
  • 8Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.

Abstract

BACKGROUND: 

The blacklegged tick Ixodes scapularis transmits Borrelia burgdorferi (sensu stricto) in eastern North America; however, the agent of Lyme disease is not the sole pathogen harbored by the blacklegged tick. 

The blacklegged tick is expanding its range into areas of southern Canada such as Ontario, an area where exposure to blacklegged tick bites and tick-borne pathogens is increasing. We performed a systematic review to evaluate the public health risks posed by expanding blacklegged tick populations and their associated pathogens.

METHODS: 

We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for conducting our systematic review. 

We searched Ovid MEDLINE, Embase, BIOSIS, Scopus and Environment Complete databases for studies published from 2000 through 2015, using subject headings and keywords that included "Ixodes scapularis", "Rickettsia", "Borrelia", "Anaplasma", "Babesia" and "pathogen." 

Two reviewers screened titles and abstracts against eligibility criteria (i.e. studies that included field-collected blacklegged ticks and studies that did not focus solely on B. burgdorferi) and performed quality assessments on eligible studies.

RESULTS: 

Seventy-eight studies were included in the final review, 72 were from the US and eight were from Canada (two studies included blacklegged ticks from both countries). Sixty-four (82 %) studies met ≥ 75 % of the quality assessment criteria. 

Blacklegged ticks harbored 91 distinct taxa, 16 of these are tick-transmitted human pathogens, including species of Anaplasma, Babesia, Bartonella, Borrelia, Ehrlichia, Rickettsia, Theileria and Flavivirus. 

Organism richness was highest in the Northeast (Connecticut, New York) and Upper Midwest US (Wisconsin); however, organism richness was dependent on sampling effort. 

The primary tick-borne pathogens of public health concern in Ontario, due to the geographic proximity or historical detection in Ontario, are Anaplasma phagocytophilum, Babesia microti, B. burgdorferi, Borrelia miyamotoi, deer tick virus and Ehrlichia muris-like sp. 

Aside from B. burgdorferi and to a much lesser concern A. phagocytophilum, these pathogens are not immediate concerns to public health in Ontario; rather they represent future threats as the distribution of vectors and pathogens continue to proliferate.

CONCLUSIONS: 

Our review is the first systematic assessment of the literature on the human pathogens associated with the blacklegged tick. As Lyme disease awareness continues to increase, it is an opportune time to document the full spectrum of human pathogens transmittable by blacklegged ticks.

KEYWORDS: 

Bacteria; Blacklegged ticks; Infectious disease; Ixodes; Parasites; Pathogens; Public health; Symbionts; Vector-borne; Viruses; Zoonoses
PMID:
 
27151067
 
[PubMed - in process] 

 

Thursday, May 5, 2016

Malaria and Malaria-like organisms (Babesia)

Very technical, but some readers may find this interesting. I found this on a medical doctor and chronic disease research listserv. It caught my attention because I have recently been read diagnosed with Babesia. 

 -Bob

This describes the process of Malaria organisms living and dying, the red blood cell involvement and the affect of a drug called chloroquine on Malaria- which is similar to Babesia. It may help those who have Babesiosis to know the organism eventually drowns in its own waste products, a fitting death for such a wicked parasite if you ask me.  

Antimalarial

Hemozoin formation in P. falciparum: many antimalarials are strong inhibitors of hemozoin crystal growth.

Inside red blood cells, the malarial parasite, which is then in its asexual lifecycle stage, must degrade hemoglobin to acquire essential amino acids, which the parasite requires to construct its own protein and for energy metabolism. 

Digestion is carried out in a vacuole of the parasitic cell.

Hemoglobin is composed of a protein unit (digested by the parasite) and a heme unit (not used by the parasite). 

During this process, the parasite releases the toxic and soluble molecule heme. 

The heme moiety consists of a porphyrin ring called Fe(II)-protoporphyrin IX (FP). 

To avoid destruction by this molecule, the parasite biocrystallizes heme to form hemozoin, a nontoxic molecule. Hemozoin collects in the digestive vacuole as insoluble crystals.

Chloroquine enters the red blood cell, inhibiting the parasite cell and digestive vacuole by simple diffusion. Chloroquine then becomes protonated (to CQ2+), as the digestive vacuole is known to be acidic (pH 4.7); chloroquine then cannot leave by diffusion. 

Chloroquine caps hemozoin molecules to prevent further biocrystallization of heme, thus leading to heme buildup.  Chloroquine binds to heme (or FP) to form the FP-chloroquine complex; this complex is highly toxic to the cell and disrupts membrane function. 

Action of the toxic FP-chloroquine and FP results in cell lysis and ultimately parasite cell autodigestion. 

In essence, the parasite cell drowns in its own metabolic products.[27] 

Parasites that do not form hemozoin are therefore resistant to chloroquine.[28]  



Wednesday, May 4, 2016

Parkinson's, depression and the switch that might turn them off

This is pretty exciting stuff. See how a woman with terrible tremors from Parkinson's disease instantly stops shaking, and how depression and Alzheimer's also respond to deep brain stimulation.

Parkinson's, depression and the switch that might turn them off
https://www.ted.com/talks/andres_lozano_parkinson_s_depression_and_the_switch_that_might_turn_them_off?utm_source=tedcomshare&utm_medium=email&utm_campaign=tedspread